Vacant Property Insurance |

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Quote Vacant Property

If you own multiple vacant properties please perform a separate submission for each vacant property to be quoted

Coverage type(s) Check all that apply*

Just Liability

Just Property

Package both liability and property

Is this insurance for Personal or Commercial Vacant Property?*

Vacant Personal Dwelling or home

Vacant Commercial Building

Vacant Personal Land

Vacant Commercial Land

For what period of time will you need this coverage?*

3 Months

6 Months

9 Months

12 Months

Other

How long will you need this? 3 months is the minimum period

Name of Vacant Property (optional)

Name of person making this request*

Phone*

REQUESTED POLICY EFFECTIVE DATE

This is a reference to the requested effective date. By submission of this form coverage will not take affect until you are contacted by our agency and review the terms, arrange for signature of forms and make an installment payment. And then at that time we will request coverage and notify you once coverage is bound. Coverage is not bound until we notify you in writing. (209) 223-1870.

Email*

Enter Email Confirm Email

Named Insured: Name of Entity or Individual(s) who own the property*

Type of Entity*

Individual(s)

Partnership

Corporation

LLC

Trust

Other

How long have you owned this property?*

How long has the property been vacant?*

What is the intended disposition of this property?*

Sell

Rent

Occupy

Demolition

Remodel

What was the prior occupancy?*

What is the intended occupancy? (i.e. single family, multiple family, retail, industrial?*

Describe the neighbor hood (rural, suburban, commercial)

What is the expected length of the vacancy?*

How often is the building checked and by whom?*

Is there a mortgage on this property?*

Yes

Are there any renovations planned for this property?*

Yes

Has the "majority" owner filed bankruptcy in the last five years?*

Yes

Is the building "completely" vacant?

Yes

Please describe other current occupancies

Is this Property on the National Register of Historic Places?*

Yes

Do you use a Property Management Company?*

Yes

Photos of each building "front and back"

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 128 MB, Max. files: 10.

Need Quote by Date:

Current Insurance Policy Expiration date:

Do you own or lease the property?*

Own

Lease

Are you in the process of purchasing this property?*

Yes

Purchase price*

Do you own vacant lots in conjunction with your vacant property?*

Yes

List all vacant lot address (separate by semicolon):*

Is the property accessible by road?*

Yes

What steps, if any, have you taken to protect your property from wildfires.

Is the property located outside of the city limits?*

Yes

Name of responding fire department*

Distance to fire hydrant*

None

0-500 ft

500-1,00 ft

Over 1,000 ft

Is there a swimming pool?*

Yes

Cause of loss coverage type*

Basic

Broad

Special

Excluding Theft

Including Theft

Excluding Sprinkler leakage

Excluding Vandalism

Vacant Property Address*

Street Address Address Line 2 City State ZIP Code

Year Built*

Number of stories*

Square footage

Construction Type*

Building Updates

Year of update to Plumbing?*

Year of updates to Electrical*

Year of update to Heating?*

Year of update to Roof*

Describe general condition of property*

How is building secured from entry?

Is there a functional burglar alarm?

Yes

Is structure sprinklered?

Yes

Is there existing structure damage? (fire, wind, etc?)

Yes

Please describe damage

General Liability Information

Limits Desired*

$300,000 per occurrence / $600,000 aggregate

$500,000 per occurrence / $1,000,000 aggregate

$1,000,000 per occurrence / $2,000,000 aggregate

Please describe any specific hazards: (water exposures, outside storage, ctc.)

Is the structure on a piece of land that is greater than 5 acres?*

describe the land and use

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